If you’re weird… act normal

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Today, Dr Una Coales is facing an unexpected media storm.

She wrote a book, three years ago, advising doctors who wished to pass their Royal College of General Practitioners exams (the ones you pass after you’re a real doctor, but before you can be a GP – which is a family doctor in the UK) that if they’re having trouble passing their oral/roleplay exams, something other than their medical knowledge might be the trouble.

She advised:
Gay students: act straight.
Women students: don’t wear a floral print dress – people will think you’re a nurse.
Ethnic minorities: if you’re in Scotland or Wales, try to sound Scottish or Welsh.
Fat people (male, presumably): acquire a ‘Santa Claus’ persona.

And for this, she appears to be being witch-hunted through the halls of the Royal College of GPs.

I wonder if this is because it’s very, very embarrassing for the RCGP to have it revealed that a) someone thinks that they don’t assess students wholly on competence and b) it has taken them three years (and someone posting on Twitter) to notice?

Dr Coales is being portrayed as racist, discriminatory, demeaning, and a whole lot of other nasty things. But let’s actually take a look at this.

Gay students – act straight
OK, do we think that there is no prejudice against gay men? Let’s all think about our acquaintances, shall we, particularly those with a Y chromosome. Do we think those possessors of a penis will be more comfortable talking to a straight or a gay GP? Ideally, it should make no difference – doctors aren’t supposed to make the moves on patients, and that’s the only time someone’s sexuality should matter – but I don’t think we’re quite at that Utopian state of tolerance yet.

So we if acknowledge that some patients might be happier (and some examiners, says Dr Coales) with a straight-seeming doctor, surely amending his body language is something our aspiring GP ought to at least consider? And, of course, this also applies to those chaps who will chase anything in a skirt but just act camp.

Women students – don’t wear a floral print dress or they’ll think you’re a nurse
OK, we’re in the twenty-first century here. Girls are allowed to be doctors, and it’s been that way for more than a hundred years. But while less than half of junior doctors are women, more than 90% of nurses are. The statistics are against us, ladies.

Also, nursing is traditionally ‘girly’, and if you wear a girly dress, people will think you have a girly job. Doctoring is more traditionally male, is certainly seen as a higher class of job (something to do with not having to take people to the loo, I think) and is more traditionally linked with ‘power’ dressing. Dr Coales may have overstated things slightly, but she does have a point.

Your clothes say something about you, people. Make sure what your clothes are saying is what you want them people to hear.

Ethnic minorities, if you’re in Scotland or Wales, try to sound Scottish or Welsh
Well, duh.
This also applies to everyone else. Your voice says all sorts of things other than words. Just you look at the internet pages on ‘most trusted accents’. Some accents, which I shall not name for fear of having my windows broken, sound like they’d steal the wheels off your car as soon as look at you. I don’t know about anyone else, but I find my voice changes depending on circumstances. Normally I don’t have much of a regional accent, but if I’m faced with a difficult conversation, my old accent comes out. And you know what? It works. I’m one of the lucky people with a ‘trustworthy’ regional accent, and I find that people calm down and are more likely to listen when I use it.

But this was not what Dr Coales was on about. Although she is being vilified for being against ethnic minorities’ accents, and for telling them to talk with a Scottish or Welsh accent, she actually only says to do this if practising in those areas. Presumably, she would also advise an Indian student practising in Liverpool to try to develop a Liverpudlian accent.

This is nothing to do with the desirability, or otherwise, of having an Indian (or other) accent, and everything to do with your voice saying I am someone like you; I am someone you can trust. It also aids understanding. I can’t imagine a consultation getting very far if neither understands the other’s accent. I used to work up in the North East of England, and I’ve encountered accents up there that were impenetrable even to me, and I used to have family up there so I was used to that particular accent. I’ve also got an elderly aunt (possessor of a strong regional accent) who changed her doctor partly because she couldn’t understand anything he said.

Fat people – develop a Santa Claus persona
This plays right into our expectations. It’s OK for Santa to be fat (in fact, can you imagine a thin Santa?) but it’s not OK for anyone else to be fat because it’s unhealthy. We are happy with fat-and-jolly because it’s a stereotype we know and with which we are familiar. Once we’ve stereotyped someone, we can stop thinking about them and get down to business. Probably quite important if you’ve got to sort out someone’s health in whatever the standard consultation length is.

Maybe we shouldn’t be vilifying Dr Coales. Maybe we should be thinking about what she’s actually saying, and why she’s saying it. We need to accept that people are different, yes. We need to not discriminate against people who are different in whatever way. But those of us who are different also need to acknowledge the effect our differences have on others.

Yes, you have a right to be yourself. But equally, you need to realise that if you do not fit the box marked ‘normal’ you will pay a price for it – justly or unjustly.

You can either be different and damn the consequences, or you can consider whether there might be any little changes that you could make without compromising your identity and individuality that might make your life easier. Also, if you are in a position of trust and responsibility, dealing with the vulnerable (and also the ignorant, and the stupid) – such as a doctor – you need to consider that some people are just not as enlightened as you are. If you’re going to deal with them profitably, and if you are going to be able to give them the help that they need, then you need to not scare them.

We find strange things frightening; and to some people, gay, ethnic minorities, even women in positions of authority, are all strange and therefore frightening. There is a time and a place for campaigning for the rights of oppressed minorities, but while dealing with someone who is only reacting badly to you because you’re just outside their comfort zone, rather than because of anything specific, is not it.

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